Nursing homes may be unable to keep up with aging population
Lackawanna County's institutional capacity to house elderly people tracks a diminishing trend statewide.
The county had an 8 percent decline in nursing home beds from 2000 to 2012 virtually the same as the state's decrease, the most-recent Pennsylvania Department of Health figures show. Personal-care home capacity in the county dropped by 5 percent from 2008 to 2011, the only data available from the state Department of Public Welfare. During the same period, statewide personal-care home beds decreased by 4 percent.
Lackawanna County's nursing home population in 2010 remained virtually the same as 2000, Census Bureau data reveal, as the statewide total declined by almost one-quarter.
Reasons for the decrease in institutional availability include tighter state regulations, shrinking Medicaid reimbursements for nursing homes and more emphasis on home and community care for the elderly.
But 15 percent of the state and county population - the largest single age segment - falls in the 45 to 54 age range, census statistics indicate. As those people start moving toward senior status over the next decade, a shortage looms in the availability of long-term care.
The state's population of 65-plus residents advanced by 2 percent from 2000 to 2010, census figures indicate. Currently, 15.5 percent of the state's residents are age 65 and older.
The Penn State Data Center projects the proportion will increase to 18.7 percent in 2020 and 22.5 percent in 2030.
"Down the road, we will not have adequate capacity in nursing homes and we will not have adequate capacity in personal-care and assisted-living facilities," said Stuart Shapiro, M.D., executive director of the Pennsylvania Health Care Association, a nursing home trade group in Harrisburg. "We are heading for a crunch."
The county's population of people age 65 and older decreased by 9 percent from 2000 to 2011, census data show. That drop reflects a slump in the nation's birth rate starting in 1932 during the Great Depression and ending in 1942, Dr. Shapiro said.
The local population of people age 85 and older, though, increased by 18 percent over the last decade. Virtually one-fifth of the county's population is 65 or older.
Pennsylvania's nursing-home population in 2010 totaled 87,775, a decrease of 26,338 residents from 2000, census figures show. Over the same period, Lackawanna County's nursing-home resident community expanded by 38 residents to 2,440.
"We are living longer, but the side effect here is that there are more frail elderly people out there," said Mark Pauly, Ph.D., a health care economist at the University of Pennsylvania.
The county's nursing home occupancy averages 92 percent and more than two-thirds of residents rely on Medicaid benefits for payment, according to Dr. Shapiro's group.
"There are definitely available beds in Northeastern Pennsylvania," he said.
But Medicaid, a health insurance program for the poor and funded by federal and state governments, has suffered a crisis as costs mount, state tax revenues plummeted from the recession and more people filed for medical assistance insurance because of continuing high unemployment.
"Medicaid is going broke paying for long-term care today," Dr. Shapiro said.
The state reduced funding for nursing home care from 9.8 percent of all health-care spending in 1999 to 8.9 percent in 2009, according to the latest data from the Kaiser Family Foundation, a San Francisco-area nonprofit that researches health-care issues.
"We haven't had an increase in Medicaid funding in, I think, five years," said Michael Wylie, of Clarks Green, vice president of development for Genesis HealthCare Corp., a Philadelphia-area long-term-care company that owns 36 facilities in Pennsylvania, including Abington Manor and Willowbrook Genesis Healthcare in South Abington Twp., Riverstreet Manor and Riverview Ridge in Wilkes-Barre.
"We've been struggling to make ends meet," Wylie said. "My costs continue to accelerate and our need to provide benefits to our employees and the costs of supplies continue to increase. Most skilled-nursing facilities are operating on a 1 percent margin."
The county has 18 nursing homes with 2,350 beds, according to the Department of Health, down from 20 facilities with 2,535 beds in 2000.
"You are seeing nursing homes go out of business because they can't rely on the Medicaid model anymore," said Michael Kelly, president of Senior Health Care Solutions, a Scranton long-term-care provider that owns Scranton Manor Personal Care Center and is constructing the Gardens at Green Ridge, a personal-care facility in Scranton. "Our elderly population has a lot of medically complicated issues. We have sick old people. Our costs are escalating daily."
Nursing and personal-care homes have changed their business model to confront the funding imbalance. They take more short-term patients who need rehabilitation and whose costs are covered partly by Medicare, the federal health-insurance program for seniors.
In the early 1990s, the average stay at a nursing home was about 465 days, Wylie said.
"Our length of stay is probably down to about 58 days," he said. "We have more people that come in for 10 to 12 days for rehab and go home."
Shorter stays help cushion against the Medicaid reimbursement pinch, Kelly said.
"You try to treat them, get them stable and get them to the least-restrictive environment," he said.
For the state, home is the best environment. The state tightened the approval process for nursing homes receiving Medicaid payments in the late 1990s, and began a transition program that has transferred more than 8,000 people from institutional care to home and community-based settings.
The state increased spending on residential and personal-care treatment from 7.1 percent of health-care outlays in 1999 to 7.3 percent in 2009, according to the Kaiser Family Foundation.
"The fact is that some people who used to be incapacitated at 80 are hale and hearty into their 80s," Dr. Pauly said. "Sooner or later the (long-term-care) demand has to be there no matter how much substitution you can do by home. The need is growing, but the ability or the willingness to pay or satisfy it is not growing as rapidly."
More family members are caring for aged relatives, keeping more people out of long-term care, Wylie said.
"With the economy being what it is, people say, 'Why should we spend $2,000 or $3,000 a month when we can keep mom at home? It's better for us financially and it's better for her,' " he said.
Personal-care homes, which provide residential settings for dependent people who do not need the individual attention and medical treatment provided at nursing homes, have struggled under tighter regulation and the embattled economy. They rely on different funding than nursing homes because they are ineligible for Medicare and Medicaid reimbursements.
The number of personal-care homes in Pennsylvania decreased by 27.5 percent from 2000 to 2011 and their capacity dropped by 16 percent, state data show.
The state toughened licensing criteria for personal-care homes in 2005, particularly in the administration of medication, staff training and fire safety requirements.
"We closed down a lot of unsafe homes around the state," said Anne Bale, a spokeswoman for the Department of Public Welfare, which regulates personal-care homes. "Our licensing standards are more strict and we weeded out a lot of the troubled homes."
The county also has a mix of residential options for seniors in public housing and private developments. The three public agencies, Lackawanna County, Scranton and Carbondale housing authorities, have more than 1,000 apartments for seniors and people with disabilities.
Lackawanna County Housing Authority is the only agency of the three with a waiting list for seniors. About 325 elderly people are waiting for government-subsidized apartments to open up, said James Dartt, executive director.
"The elderly buildings are always occupied," he said. "There is always a need for the apartments."
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